ORAL' MANIFESTATIONS IN SYSTEMIC DISEASES ...

H. H. STONES
predisposing factor is loss of the vertical dimension of the bite and
consequent sagging of the tissues as occurs in elderly edentulous patients.
Hence it is necessary to correct this loss (Ellenberg and Pollack, 1942;
Mann, Mann and Spies, 1945; Mann, Dreizen and Spies, 1948).
A painful glossitis is a feature in which there is sometimes engorgement
of the fungiform papillae, the denuded summits of which permit the
underlying capillary loops to appear as red elevations. It may be a
magenta colour. Later there is atrophy of the papillae so that the
tongue appears glazed, shiny and fissured.
Other rarer features that have been reported are inflammation of the
eyelids, conjunctivitis, disturbances of vision, and desquamation of the
epithelium of the nasolabial folds, alae nasi, eyelids and ears.
Nicotinic acid deficiency.-Pellagra is the chief disease associated with
a deficiency and in this Spies, Bean and Asche (1939) point out that
there is a multiple deficiency of the vitamin B complex including that of
riboflavin and aneurin. Secondary pellagra, in which there is failure to
assimilate the vitamin, has been described as occurring in association
with chronic intestinal disturbances such as peptic ulcer, carcinoma of
the stomach and ulcerative colitis (Bean, Spies and Blankenhorn, 1944).
In the early stages the tip and margins of the tongue become red.
This intensifies and the tongue becomes swollen and has a burning
sensation. As the condition progresses the lingual papillae atrophy
and there is desquamation of the superficial epithelial layers leaving a
red, smooth and glazed surface (Kruse, 1942). Gingivitis or stomatitis
which may be associated with fusospirochaetal organisms may develop,
the inflammation starting at the interdental papillae and progressing
until the gingivae are ulcerated. There is inflammatory involvement of
other mucous membranes of the alimentary tract and sometimes of the
perineum and vulva.
Other features include dermatitis with the formation of small
erythematous patches that eventually turn brown and desquamate. There
may be mental symptoms of varying severity.
The pellagrin often complains of tingling and numbness of the
extremities which are characteristics of beri-beri which may co-exist with
the disease.
The administration of nicotinic acid produces a striking improvement
in the inflammation of the mucous membranes, skin lesions and mental
symptoms. It does not, however, cure the angular lesions of the mouth
which arise from riboflavin deficiency, or the peripheral neuritis which is
due to aneurin deficiency.
Pyridoxine deficiency.-There is obscurity regarding the effects of
pyridoxine deficiency in man and no definite conclusions have been
reached. With the introduction of one of the antimentabolites desoxypyridoxine,
limited tests have been carried out on its effect. Mueller
and Vilter (1950) report eight cases who received 60 mgs. or 150 mgs. of
desoxypyridoxine daily. The other components of the B complex were
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